Homestead_Boyleaa� CLAIM FOR HOMESTEAD PROPERTY TAX ' / FORM YEAR
CREDIT /STANDARD DEDUCTION VVV HCio
S State Form 5473 (R215 -92)
INSTRUCTIONS: See reverse side for Tiling instructions.
CERTIFICATION STATEMENT
I (We) K-, wnzjA (3 certify that on the 1 st day of March, 19
I (We) occupied as our pr cipal place of residence the following de rl a real pr rty for which a Homeste6d� )0( Cby claimed:
W(We) owned ❑ Are buying under contract AUDITOR
.Have a beneficial interest in the entity that is liable for the property taxes on the property and that owns the property or is buying under a contract.
CONTRACT RECD ED
It buying on contract, Fee Simple owner's name j ') k^ I I q
contract
Record number
PROPERTY OWNED BY CLAIMANT IN OTHER COUNTIES
' PROPERTY DESCRIPTION
Count
wnship
Tax" g district (city, tow township)
�/�%c
6qjoi✓
S ature of daimant
orn�P
Parcel number
oos- 0.37
tLoe ga l description
(✓ - - a
It any portion of the residential structure or the land not exceeding one (1) acre that immediately surrounds that structure is used to produce income, describe the use and portion
of the property utilized to produce income.
,( �j/}
0 —e/ ,
PROPERTY OWNED BY CLAIMANT IN OTHER COUNTIES
County
Township
County
Township
I hereby certify the above statements are true, correct and complete.
S ature of daimant
Valuation or $2,000
'M ass (number and street city, state. ZIP code)
it (�
ASSESSOR USE ONLY
TRUE TAX
,VALUE
ASSESSED
VALUE
HOMESTEAD
VALUE
NON - RESIDENTIAL
VALUE
Land not exceeding 1 (one) acre immediately
surrounding residential improvements.
(1)
Valuation or $2,000
Signature of Autlitor
Other land
(2)
Total land (line 1 plus line 2)
(3)
Residential improvements
Dwelling
(4)
-
Garage
(5)
Other improvements
(6)
Total improvements (line 4 through line 6)
(7)
Total value (line 3 pUs line 7)
(6)
1 hereby certify the above is true, correct, and
complete.
Signature of Assessor
Date signed
Verifying action - Signature of Auditor
Date signed
S STANDARD DEDUCTION ALLOWANCE
19_Pay 19_
Lesser of 112 Homestead
$
Valuation or $2,000
Signature of Autlitor
Date signed —
Iml